The Impact of Alcohol on PrEP Adherence in Vulnerable Men

项目摘要和摘要 酒精是男同性恋者和双性恋者(GBM)中最普遍使用的物质。此外，酒精是 与GBM文化有着千丝万缕的联系，经常被用作性行为的前驱或促进者。酗酒 性行为往往涉及性行为，使人们有更高的艾滋病毒血清转换风险 无避孕套的肛交。暴露前预防(PrEP)在预防艾滋病毒血清转换方面是有效的，但 推荐的药物配方是服药依从性中等偏高的每日药片。 有效。与不使用物质相比，使用物质的GBM具有较低的依从性 GBM，但很少有研究调查饮酒对PrEP依从性的影响。 因此，拟议的研究将收集试点数据，以调查酒精使用和滥用对 准备遵守。在这个指导职业发展奖(K01)中，Westmoland博士将描述模式 在使用PrEP的人群中酒精使用和性行为的关系，确定酒精使用在日常生活中所起的作用 使用多种方法准备遵守情况，收集汇总数据(例如，30天)和详细数据(例如，生态数据 瞬间评估(EMA)数据，并将PrEP不遵守与饮酒有关的情况联系起来。 在目标1中，Westmoland博士将使用基线定性和定量数据来描述酒精的模式 使用和性行为。她还将使用定性采访中的叙述来增加不断增长的 有关PrEP吸收和参与PrEP护理连续体的障碍的文献。在《目标2》中，Dr。 Westmoland将使用多种数据来源--即定量调查、时间线后续访谈 (TLFB)，每周收集两次的日记条目，为期10周(即EMA数据)，以及干血迹(DBS) 酒精和PrEP依从性监测标本--定量确定酒精在 每天遵守PrEP。通过使用多种数据收集技术，她还将能够准确地 验证对酒精使用和PrEP遵守情况的估计。在《目标3》中，威斯特摩兰博士将使用定性数据 从跟踪访谈到说明与饮酒有关的PrEP不遵守情况。另外， 她将利用这些后续访谈来帮助描述参与者在 可能导致PrEP日常使用偏差的后续时间段。威斯特摩兰博士将在她之前的基础上 作为性传播感染和艾滋病毒流行病学家接受培训，将她的专业知识扩展到酒精研究并开发新的 进行有影响力的性行为研究所需的分析技能。这些技能将包括收集和 分析定性数据；使用EMA、TLFB和DBS数据；实施科学、拨款撰写和 科学交流。通过课程作业和讲习班、以酒精为重点的讲习班和 研讨会、指导和专业会议，Westmoland博士将获得她需要申请的技能 她获得了第一笔R01奖金，并以终身教职首席研究员的身份从事艾滋病毒预防研究。

PROJECT SUMMARY AND ABSTRACT Alcohol is the most prevalently used substance among gay and bisexual men (GBM). Additionally, alcohol is inextricably linked to GBM culture and often used as a precursor or enabler of sexual activity. Alcohol-involved sex often involves engaging in sexual behavior that places persons at higher risk for HIV seroconversion such as condomless anal sex. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV-seroconversion, but recommended medication formulations are daily pills with moderately high levels of adherence to be most effective. Substance-using GBM have been shown to have lower levels of adherence compared to non-using GBM, but scant research has investigated the impact that alcohol consumption has on PrEP adherence. Therefore, the proposed study will collect pilot data to investigate the effects of alcohol use and misuse on PrEP adherence. In this mentored career development award (K01), Dr. Westmoreland will describe patterns of alcohol use and sexual behavior among PrEP-using GBM, identify the role that alcohol use plays in daily PrEP adherence using multiple methodologies to collect aggregate (e.g., 30 day) and detailed (e.g. ecological momentary assessment (EMA)) data, and contextualize PrEP non-adherence related to alcohol consumption. In Aim 1, Dr. Westmoreland will use baseline qualitative and quantitative data to describe patterns of alcohol use and sexual behavior. She will also use the narratives from qualitative interviews to add to the growing literature surrounding barriers to PrEP uptake and engagement in the PrEP care continuum. In Aim 2, Dr. Westmoreland will use multiple sources of data—i.e. quantitative surveys, timeline follow-back interviews (TLFB), diary entries collected twice-weekly for 10 weeks (i.e. EMA data), and dried blood spot (DBS) specimens for alcohol and PrEP adherence monitoring—to quantitatively identify the role that alcohol plays in daily PrEP adherence. By using multiple data collection techniques, she will also be able to pinpoint and validate estimates of alcohol use and PrEP adherence. In Aim 3, Dr. Westmoreland will use qualitative data from follow-up interviews to contextualize PrEP non-adherence related to alcohol consumption. Additionally, she will use these follow-up interviews to help characterize participants’ perceived changes in risk over the follow-up time period that could lead to deviations from daily PrEP use. Dr. Westmoreland will build on her prior training as a STI and HIV epidemiologist to expand her expertise into alcohol research and develop new analytical skills needed to conduct impactful sexual behavior research. These skills will include collecting and analyzing qualitative data; working with EMA, TLFB, and DBS data; implementation science, grant-writing, and scientific communication. Through methods coursework and workshops, alcohol-focused workshops and seminars, mentorship, and professional meetings, Dr. Westmoreland will gain the skills she needs to apply for her first R01 grant and pursue a career in HIV prevention research as a tenure-track principal investigator.